Based on evidence and experience, countries worldwide are adding the option of DMPA-SC self-injection to their contraceptive method mix.
Self-injection has the potential to reduce access-related barriers for women, increase contraceptive continuation rates, and enhance women’s autonomy. There are strong data that women, including women in low-resource settings, can self-administer DMPA-SC safely and effectively, and that they like doing so.
On September 15, 2021, the PATH-JSI DMPA-SC Access Collaborative hosted this virtual launch and walk-through of the redesigned DMPA-SC Country Data Dashboard and new monitoring, learning, and evaluation (MLE) tools.
The AC data dashboard is an interactive tool that presents available data collected during DMPA-SC self-injection (SI) introduction and scale-up. The dashboard visualizes SI uptake, tracks implementation of key policies, and integrates data use practices to support data-driven decision making. Information presented on the dashboard has changed over time to reflect shifting needs of stakeholders. After undergoing a human centered design exercise to better understand information needs surrounding SI introduction and scale-up, the Access Collaborative recently redesigned the DMPA-SC Country data dashboard. This webinar introduced new data available and demonstrated new features on the dashboard.
The webinar also included an overview of the Access Collaborative’s new MLE toolkit developed to help meet the needs of ministries of health and implementing partners. This toolkit features three tools for dynamic decision-making: a data visualization principles guide, an Excel dashboard how-to guide, and a data use and indicators guide. The tools are primers in how to create dynamic and visually compelling SI program data displays (e.g., dashboards, presentations) that facilitate comprehension and use of SI data for family planning program decision-making. While the toolkit was developed with SI in mind, many of the principles could be applied to data visualization needs across family planning programs and methods.
Data has the power to convey the lived experiences of women and adolescents, highlighting the importance and potential of expanding choices to reduce unmet need for contraception. This monitoring, learning, and evaluation (MLE) toolkit features three tools for dynamic decision-making: A data visualization principles guide, an Excel dashboard how-to guide, and a data use and indicators guide. These are primers on how to create dynamic and visually compelling self-injection program data displays (e.g., dashboards, presentations) that facilitate comprehension and use of self-injection data for family planning program decision-making. While the MLE toolkit was developed with self-injection in mind, many of the principles could be applied to data visualization needs across family planning programs and methods. For more information about using the toolkit, visit Excelerate your self-injection program data: An Excel skill-building workshop series.
We want to hear from you! By completing this short survey, you can help us ensure the tools are meeting the needs of key stakeholders during new product introduction and scale-up. Please contact FPoptions@path.org with any questions or request for assistance.
This webinar hosted by the DMPA-SC Access Collaborative Learning and Action Networks (LAN) on July 21, 2021 highlighted important considerations for private pharmacies in data collection and reporting on self-care products such as DMPA-SC self-injection. Presenters shared their experiences and lessons from introducing DMPA-SC self-injection through private delivery channels in their respective countries.
The specific types of self-injection data collected across countries.
Best practices for engaging and motivating private sector pharmacies and drug shops to provide data to the public sector.
Tools used by pharmacies to collect self-injection data.
This virtual discussion encouraged all stakeholders—program implementers, researchers, government officials, health providers, and civil society members—to consider private sector perspectives on data collection and reporting practices, highlighting the importance of good private sector data to inform government policies and strategies for monitoring, regulating health products, and procurement.
The DMPA-SC Access Collaborative hosted this April 21, 2021 webinar highlighting lessons learned to date through four years of data-driven technical assistance and coordination to ensure that women have increased access to self-injection as a contraceptive option, delivered through informed choice programming. The discussion focused on key topics for the introduction and scale-up of self-injection—and self-care interventions more broadly—at the country level including:
Policy and advocacy for new product introduction.
How to coordinate scale-up of a new product.
Using data to inform program introduction and scale-up.
Effective innovations and adaptations in provider training.
This discussion was moderated by Monica Mutesa, Zambia Country Coordinator, DMPA-SC Access Collaborative, PATH. Speakers included:
In this Making Self-Injection Count workshop session, participants were engaged in a lively discussion and interactive collaboration around the important considerations for private sector data collection and reporting on self-care products such as DMPA-SC. This session began with a short presentation to set the stage on the important role of private sector and data within the context of mixed health systems. Participants joined a moderated discussion with three in-country implementers from Nigeria (DKT), Uganda (PSI) and Zambia (JSI) who shared their experiences and lessons from introducing DMPA SC self-injection and other self-care products through private delivery channels. The session concluded with a facilitated, interactive activity to identify and prioritize private sector data needs.
By the end of the session, participants were able to:
Characterize the private sector within the context of the total market for DMPA-SC and other self-care products.
Describe the current landscape for provision of DMPA-SC self-injection through the private sector.
Identify the unique considerations and feasibility for collecting private sector data within mixed health systems.
The private sector is highly diverse and fragmented, comprised of profit and non-for-profit, formal and informal, domestic and global non-state actors. A total market approach (TMA) considers all channels of service delivery–public and private–to increase equitable and sustainable access to health products and services by maximizing the comparative advantage of all sectors. TMA builds upon market segmentation, using various channels to expand the overall market and meet demand for family planning, particularly where the public sector is not meeting women’s preferences/needs.
Aligning and harmonizing data in mixed health systems is complicated. Different types of data are needed at various levels to understand the total market. By taking a holistic perspective–one that considers both the public and private sectors–we can identify the opportunities and gaps that exist at client, provider and systems level to guide policy, program, and investment decisions. Some data is more readily available, such as public sector procurement and distribution trends. However, other data, such as consumer retail price, willingness to pay or volumes of product sold, are often less available due to a variety of reasons, and sometimes require additional research.
It is important to engage and understand the perspectives of the private sector when it comes to data collection/reporting desires and needs of governments and other stakeholders.
Ariella Bock, Senior Technical Advisor, JSI
Mika Bwembya, Health Supply Chain and Total Market Director, USAID DISCOVER Health Project
Kimberly Cole, Private Sector Service Delivery Programs, USAID’s Global Health Bureau’s Office of Population and Reproductive Health
Tanvi Pandit-Rajani, Private Sector & Health Markets Lead, JSI
Participants in this Making Self-Injection Count workshop session learned about interim data sources for self-injection data, including Performance Monitoring for Action (PMA) surveys, demographic and health surveys (DHS) surveys, and low-resource, short-term auxiliary data collection systems. This session also highlighted efforts made to collect and use family planning data in humanitarian settings. Presenters addressed general timelines for data access in different countries and evaluated differences in indicators across data sets.
By the end of the session, participants were able to:
Describe how questions on self-injection are being incorporated into broader surveys and get a sense of the timeline for when self-injection survey data will become available in select countries.
Describe alternative approaches for gathering data on self-care methods, including self-injection, when routine systems are not available.
Strategize practical solutions for accessing data in their local setting.
It can take time (one to five years) for new products to be integrated into routine information systems (HMIS/LMIS). While work is underway to integrate self-injection into routine systems, interim and complementary data solutions can fill that missing dataset.
Four considerations for interim data collection:
Clarity of rationale: Collect data critical for tracking progress and informative for decision- making.
Feasibility: use existing systems to the extent possible.
Acceptability: aim to make data collection simple for FP focal persons.
Institutionalization: collaborate and coordinate with the MOH and other partners, critically reviewing self-injection’s contribution to the method mix with the goal of adapting the HMIS to include SI data.
Phil Anglewicz, Principal Investigator, Performance Monitoring for Action (PMA) project
Joy Fishel, Senior Survey Coordinator, Demographic and Health Surveys Program
Stephen Mawa, Program Management Specialist, UNFPA South Sudan
Allen Namagembe, Uganda Country Coordinator, PATH
Avotiana Rakotomanga, Madagascar Country Coordinator, JSI
Shannon Wood, PMA, Assistant Scientist, Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health
This session wrapped up the Making Self-Injection Count workshop and highlighted key takeaways. Participants had an opportunity to reflect on what they learned and the action steps they have identified to move forward with their work.
The workshop closed with four calls to action:
Add your country’s data to the global DMPA-SC monitoring system. For more information, email FPoptions@path.org.
This was a hands-on skill-building session during the Making Self-Injection Count workshop in which participants worked with a sample data set in order to create data visualizations using Microsoft Excel. Two versions of the session were offered—a beginner session for participants with limited experience using Excel and data visualizations, and an advanced session for those with more experience. Participants needed a computer with Excel; the dataset and other materials were provided.
By the end of the session, participants were able to:
Identify key considerations for developing data visualization products.
Build a dynamic and interactive decision-making tools in Excel through a hands-on exercise.
Tailor data visualization products to meet the needs of different audiences.
Family planning data must be distilled and easy to understand to enable stakeholders to make decisions.
When developing data visualizations, ask the following:
Who is your audience?
What do they want to know?
How will you communicate it?
Stakeholders differ in their data needs and visual literacy, and the approach you use should align with the audience’s information needs.
Nicole Danfakha, Senior Data Viz Program Officer, JSI
In this practical, hands-on simulated data use session in the Making Self-Injection Count workshop, participants first learned about experiences running data review meetings in Kenya and Tanzania, highlighting lessons learned and best practices. Then they practiced skills using a mock decision-support tool to solve a common self-injection data challenge.
By the end of the session, participants were able to:
Describe key components of successful data use meetings and how data use meetings can be used to strengthen service delivery for family planning and self-care.
Identify the skills, knowledge, and competencies (i.e., role profiles) needed for an effective data use team.
Apply practical, hands-on strategies to run a data use meeting (including virtual meeting).
Data availability in HMIS/LMISes is necessary but not sufficient for efficient data use, strong service delivery, and commodity availability.
Data-use teams comprise people from various levels of the health system with a common goal, a structured approach, and tools for reviewing data and taking action. Teams are trained to use data to clearly define and prioritize problems, conduct a root-cause analysis, and recognize small wins and good performance.
There are seven key roles of an effective data-use team. Team members may assume different roles depending on the context and the problem being addressed.
Organizer (logistics, agenda, notes).
Problem solver (questions why, addresses challenges, steering to root cause of problems).
Data wizard (indicators and interpretation, analysis of raw data, graph trends, visualize data).
Supply chain (deep understanding of technical areas, supply chain processes, critical analysis of systems).
Influencer (access to decision-makers, suggestions are taken seriously, advocacy).
Resource (handles/advocates for funding).
Leader (needs to endorse or support decisions, big picture/vision of the team).
Critical components for effective data use:
Deliberate design: multidisciplinary team with a common performance goal.
This session of the Making Self-Injection Count workshop took an advocacy lens to highlight the importance of self-injection data. Representatives from the Government of Malawi—which has included self-injection in their HMIS since 2019—shared an overview of their self-injection program, highlighting the process for updating their HMIS including success and challenges. They also highlighted how self-injection data has been used at the national and district program levels. Participants had an opportunity to ask questions during the question and answer session.
By the end of this session, participants were able to:
Describe the value of integrating self-care methods, including self-injection, into an HMIS.
Understand the challenges and success factors for HMIS integration.
Describe how data has been used in countries where this integration has already happened.
Inclusion of SI indicators in the Malawi national health management information system (HMIS) involved a collaborative effort among the reproductive health directorate, the central M&E division, MoH district teams, and DMPA-SC task force partners.
In Malawi, key lessons learned were:
all relevant stakeholders should be involved from the beginning to minimize back-and-forth process flow.
high-quality data and services are dependent on routine mentorship, supervision, SI counseling, and process-review meetings.
Visibility on self-injection uptake in Malawi has improved efficiency of targeted support, implementation adjustments, and supply chain management. Being able to track DMPA-SC visits stratified by self-injection versus provider administration has helped with supply management and reduction of waste, and findings on reasons for discontinuation at the facility level have informed support needs and service delivery.
Gracious Ali, Program Associate, Clinton Health Access Initiative (CHAI)
Jessie Chirwa, Family Planning Program Officer, Malawi Ministry of Health Reproductive Health Directorate
Philemon Moses, CHAD Monitoring and Evaluation Officer
Regina Mponya, Family Planning Coordinator, Malawi Ministry of Health Reproductive Health Directorate